1598707689 NPI number — NES OF FLORIDA INC

Table of content: (NPI 1598707689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598707689 NPI number — NES OF FLORIDA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NES OF FLORIDA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598707689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 403208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-377-8721
Provider Business Mailing Address Fax Number:
304-523-2241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 SW 46TH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-5752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-291-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORRA
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
631-265-7450

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 053198702 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21811 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".